Evolving Role of Liver Transplantation in Elderly Recipients

Abstract

The need for liver transplantation (LT) among older patients is increasing, but the role of LT in the elderly (≥70 years) is not well defined. We retrospectively reviewed all primary LTs from 1998 through 2016 at our center. Survival and associated risk factors were analyzed with Cox regression and Kaplan‐Meier methods for LT recipients in 3 age groups: <60, 60‐69, and ≥70 years. Among 2281 LT recipients, the median age was 56 years (range, 15‐80 years), and 162 were aged ≥70 years. The estimated 5‐ and 10‐year patient survival probabilities for elderly LT recipients were lower (70.8% and 43.6%) than for recipients aged 60‐69 years (77.2% and 64.6%) and <60 years (80.7% and 67.6%). Patient and graft survival rates associated with LT improved over time from the pre–Model for End‐Stage Liver Disease era to Share 15, pre–Share 35, and Share 35 for the cohort overall (P < 0.001), but rates remained relatively stable in septuagenarians throughout the study periods (all P > 0.45). There was no incremental negative effect of age at LT among elderly patients aged 70‐75 years (log‐rank P = 0.32). Among elderly LT recipients, greater requirement for packed red blood cells and longer warm ischemia times were significantly associated with decreased survival (P < 0.05). Survival of LT recipients, regardless of age, markedly surpassed that of patients who were denied LT, but it was persistently 20%‐30% lower than the expected survival of the general US population (P < 0.001). With the aging of the population, select older patients with end‐stage liver diseases can benefit from LT, which largely restores their expected life spans.

Aging and the Biological Response to Liver Injury

“…29,30 However, the survival of recipients older than 70 years of age still remains lower than in younger patients (10-year survival of 43 vs. 64% in recipients aged 60-69 years). 31 In addition, the development of biliary complications after orthotopic liver transplantation is influenced by donor age, 32 with important consequence on subsequent patient management.…”

Aging-Related Molecular Pathways in Chronic Cholestatic Conditions

“…The development of biliary complications after orthotopic liver transplantation is influenced by donor age (82), and lower survival rates in people aged more than 60 years (5-years survival rate of 59%) has been observed (83). However, the survival of recipients older than 70 years of age still remains lower than in younger patients (10-years survival of 43 vs. 64% in recipients aged 60-69 years) (84).…”

Liver transplantation and aging

“…A number of studies reports very good results of LT in elderly recipients. They include both single center analyses and analyses of registry data, and they all show that the outcomes for the elderly in terms of survival are similar or not much worse than in matched younger patient groups[ 8 , 15 - 19 ]. Indeed, a recent meta-analysis on LT in the elderly, shows that patient and graft survival rates are not different between younger and elderly LT recipients[ 1 ].…”